1. THEME 1:
CHANGE AGENT FOR THE 21ST CENTURY
Session 1-2: Change agent in an unknown future
Prof Ben van Heerden
Centre for Health Professions Education
Faculty of Medicine and Health Sciences
Stellenbosch University
Sentrum vir Gesondheidsberoepe Onderwys Centre for Health Professions Education
Fakulteit Geneeskunde en Gesondheidswetenskappe  Faculty of Medicine and Health Sciences

2. Outcomes
After this contact session you should
be able to do the following:
• Describe recent developments that are
related to the leadership role of health
professionals to effectively address the
health needs of the country’s population.
• Discuss the knowledge, skills and attitudes
that you need to develop to become a
capable and appropriate doctor.

3. Recent developments
• International and national
developments in the training of health
care professionals
• Transformative learning and
interdependence in education
• Graduate attributes
• Developments in leadership and
management theory (discussed in
sessions 3-4)

5. International trends in HSE
• Future of Medical Education in Canada
(2010)
• Tomorrow’s doctors (GMC, 2009)
• Reform in educating physicians (Carnegie
Foundation, 2010)
• Revisiting medical education at a time of
expansion (Macy Foundation, 2008)
• A snapshot of medical student education in
the USA and Canada (AAMC)
• Global consensus for Social Accountability
of Medical Schools (2010)

6. International trends in HSE
• Health professionals for a new century:
transforming education to strengthen
health systems in an interdependent world
(www.thelancet.com,2010;376:1923-1958)

7. South African trends and priorities
• Re-engineering primary health care in SA
(SA Department of Health)
• The contribution of South African
curricula to prepare health professionals
for working in rural or under-served
areas in South Africa: A peer review
evaluation (SAMJ, 2011;101:34-38)
• The human resource supply constraint:
The case of doctors. (Econex Health Reform
Note 8, November 2010)

8. Lancet Commission Report
J Frenk, L Chen, ZA Bhutta, et al: Health Professionals for a new
century: transforming education to strengthen health systems in an
inderdependent world. www.thelancet.com ,2010;376:1923-1958
Century after Flexner’s report – all is
not well:
• Gaps and inequities in health care
• New infectious, environmental and behavioural
risks in context of rapid demographic and
epidemiological transitions
• Health systems complex and costly

9. Lancet Commission Report
Professional education has not kept pace –
fragmented, outdated & static curricula and ill
equipped graduates:
• Mismatch of competencies to patient/population needs
• Poor teamwork skills
• Narrow technical focus lacking broader contextual
understanding
• Episodic patient encounters rather than continuous care
• Predominant hospital orientation at expense of PHC
• Weak leadership skills to improve health system
performance
• Professional “tribalism”

10. 1900 Science based Problem based Systems
2000+
based
Scientific Problem-based Competency driven;
Instructional curriculum learning Global-local
University based Academic centres Health-Education
Institutional systems
Lecturer centred Student centred Patient and
population centred
Basic sciences Small group
lectures Inter and
transprofessional
Innovations
IT empowered
learning
Leadership, policy
and management
skills
Adapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming
education to strengthen health systems in an inderdependent world.

11. Traditional educational model
Educational
objectives
Curriculum
Assessment
Competency-based educational model
Health needs Competencies
of population Outcomes Curriculum
Assessment
Adapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming
education to strengthen health systems in an inderdependent world.

12. Labour market
Supply of health for health Demand for health
workforce professionals workforce
Provision Provision
Education Health
System System
Demand HSE Demand
Needs Needs
Populatio
n
Adapted from: J Frenk L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming education to
strengthen health systems in an inderdependent world. www.thelancet.com, 2010;376:1923-1958

13. KEY DIMENSIONS OF
EDUCATION SYSTEM
Institutional design Instructional design
Proposed Outcomes
Interdependence Transformative
in Education learning
Adapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming education to
strengthen health systems in an inderdependent world. www.thelancet.com, 2010;376:1923-1958

14. Three levels of learning
• Informative learning
Learning of knowledge and skills required to
become technical expert
• Formative learning
Learning of attitudes, values and norms
required to become a professional
• Transformative learning

15. Transformative learning
• Aim: Leadership attributes
• Outcome: Change agents
• Three fundamental shifts from:
• Rote learning higher level of cognitive
functioning
• Seeking professional credentials achieving
core competencies for effective teamwork
• Non-critical adoption of educational models
creative adaptation of global resources to
address local priorities

16. Interdependence in Education
• Key element in systems-based
educational approach
• Underscores the ways in which various
components of the systems interact
• Three fundamental shifts from:
• Isolated harmonised education and health
systems
• Standalone institutions networks, alliances
and consortia
• Inwardly-focused institutions creative use of
global educational content, teaching resources
and innovations

17. Interdependence
Transformative
in
Learning
Inter and Education
transprofessional
Competency-based Leaders teams Locally responsive
Responsive to rapidly Task sharing
Change agents Globally connected
changing needs
Open educational
Creative use of IT resources
Health Equity
Patient-centred Population
based
VISION
Adapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming
education to strengthen health systems in an inderdependent world.

19. Interdependence HP for the Transformative
in Education 21st Century Learning
Three Shifts: Three Shifts:
Inter- & 1. Isolated to harmonised 1. Rote learning to
analysis; synthesis
Edu & Health Systems
Transprofessional 2. Standalone Institutions 2. Seeking credentials to
to Networks; Alliances; teamwork competencies
Teams Consortia 3. Educational models to
3. Inward looking to Global global resources
flow of educational
Task sharing content, resources,
innovation
Globally connected
Locally responsive Needs of Society and
Leaders &
Open Educational Health Systems Change agents
Resources (OER)
Harmonised Competency-driven instructional Design
Education and
Health Systems Curriculum Competencies as Outcomes

20. Outcomes
After this contact session you should
be able to do the following:
• Describe recent developments that are
related to the leadership role of health
professionals to effectively address the
health needs of the country’s population.
• Discuss the knowledge, skills and attitudes
that you need to develop to become a
capable and appropriate doctor.
GRADUATE ATTRIBUTES

21. Graduate attributes
• “…the qualities, skills and understandings a
university community agrees its students should
develop during their time with the institution.
• These attributes include, but go beyond, the
disciplinary expertise or technical knowledge that
has traditionally formed the core of most university
course.
• They are qualities that also prepare graduates as
agents of social good in an unknown future.”
Bowden et al. (2000)

22. Lancet December 2010
Health professionals have made huge
contributions to health and socio-economic
development over the past century,
but we cannot carry out 21st century health
reforms with outdated or inadequate
competencies….
That is why we call for a new round of more
agile and rapid adaption of core
competencies
based on
transnational, multiprofessional, and long-
term perspectives to serve the needs of
individuals and populations

23. The CanMEDS Competency Framework
7 Key roles necessary to effectively function as a healthcare
practitioner
Medical
Expert
CanMEDS, 2005

24. CanMEDS 2005
Level Description
Level 1 A health care professional’s (HCP) complete array of
competencies (determined by needs of community / system)
Level 2 Thematic groups of competencies (“meta-competencies”)
(e.g. 7 CanMEDS Roles)
Level 3 Key competencies thematically grouped by Role (broad
abilities)
Level 4 Enabling competencies - made up of knowledge, skills and
attitudes (sub-abilities to attain key competency)
Level 5 Profession-specific objectives of training
Level 6 Programme-level objectives
Level 7 Rotation objectives
Level 8 Instructional-event-specific objectives

25. Role of the Health Professions Council of SA
(HPCSA)
• Statutory body
• Comprising 12 Professional Boards
• Regulates education and training of health
professionals represented by these Boards
• Medical and Dental Professions Board (MDB)
• Represents Medical Doctors, Dentists, Medical
Scientists and Clinical Associates (CA)
• Undergraduate Education and Training (UET)
Subcommittee
• Oversees the E & T of CA, Dentists and Medical
Doctors

26. UET subcommittee
• Adopted the key recommendations of
the Lancet Commission
• Adapted CanMEDS competency
framework to ensure that it is
appropriate for:
• Undergraduate education and training
• All health care professionals
• South African context

27. Outcomes
After this contact session you should
be able to do the following:
• Describe recent developments that are
related to the leadership role of health
professionals to effectively address the
health needs of the country’s population.
• Discuss the knowledge, skills and attitudes
that you need to develop to become a
capable and appropriate doctor.